Mental Health Services

Baroness Thornton Excerpts

Thursday 25th June 2015 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what action they plan to take in the light of the report by the Care Quality Commission, Right Here, Right Now, regarding providing young people with adequate help, care and support during a mental health crisis.

[Baroness Thornton (Lab)]

My Lords, I know that the Minister is now almost a veteran in your Lordships’ House, but he is new to me and I have not had the opportunity to welcome him to his position, which is one that I held in the past. I hope that he will enjoy his job as much as I did, and I know that, like me, he will probably by now know his place in your Lordships’ House, given its huge expertise on health matters. If he knows that, he will almost certainly succeed in his position.

Earlier this month, the Care Quality Commission produced Right Here, Right Now, an investigation into people’s experience of help, care and support as a result of a mental health crisis. In your Lordships’ House, we fought for, and won, the battle for parity of esteem. Indeed, I am very pleased to say that it was Labour votes in the House of Lords that ensured that the Government wrote parity of esteem between mental health and physical health into law. However, I am afraid that since then it has become clear that the reality does not match the rhetoric. Despite the Government saying that they would protect front-line services, on the coalition Government’s watch the budget for child and adolescent mental health was reduced year on year, and we have seen key prevention and early intervention services stripped back, such as child and adolescent mental health services—CAMHS—and early intervention in psychosis services.

This latest report found that people’s experience of mental health crisis care was simply not good enough, with children and young people in particular experiencing very poor care. I commend the CQC for this report, which clearly shows significant variations in the help, care and support available to people in crisis, and that often a person’s experience depends not only on where they live but on what part of the system they come into contact with. The CQC asked people to share their experiences, and what people told it demonstrates a real weakness in mainstream mental health provision as regards 24-hour crisis care. In some cases, the only recourse for people trying to access crisis services is to a phone line telling them to go to their local emergency department.

For children and young people, the problems are even more acute. There is a lack of health-based places of safety for children and young people. Many units do not accept children under 16, there is the problem of places of safety being already occupied, and there is a lack of CAMHS availability to support out-of-hours care. These issues often mean that children end up travelling many miles away from home. In June 2014, the Royal College of Psychiatrists conducted a survey that revealed that 83% of those surveyed had experienced difficulty at least once in finding an appropriate bed for children and young people, and that 22% of respondents who worked in child and adolescent mental health services had placed a child 200 miles away from their family.

Right Here, Right Now reveals a disparity between adult and child crisis care, particularly in accident and emergency. It found that:

“Through our local area inspections on people presenting to A&E in crisis, we found that there were clear differences in the quality of care experienced by those under 16 compared to those over 18 years old. The liaison psychiatry service met specifications set out in the RAID model. Adults were seen promptly and there were clear pathways through to community services. People aged 16 or 17 would be seen and assessed by the RAID team with support from CAMHS, while those under 16 were referred directly to the child and adolescent mental health service … This may be an appropriate referral route, but in practice it meant that if a CAMHS referral was made after 12.00 noon, the child would not be seen until the following day or potentially after the weekend, as the CAMHS team did not offer out-of-hours service”.

The disparity in care at accident and emergency is particularly concerning given that the number of children under 18 attending accident and emergency for psychiatric conditions increased by 82.5% between 2010-11 and 2013-14.

Young Minds, an organisation that does excellent work, believes that as well as improving the response to children attending accident and emergency with mental health crises, much more should be done to provide early intervention support so that children do not end up in a crisis in the first place. A freedom of information request by Young Minds found that 74 out of 96—77%— of NHS clinical commissioning groups froze or cut their CAMHS budgets between 2013-14 and 2014-15. It also found that 59 out of 98—60%—of local authorities in England have cut or frozen their child and adult mental health services budgets since 2010-11, and that 56 out of 101—55%—of local authorities that supplied data have cut, frozen or increased below inflation their budgets in this area. It has also been revealed that 80 educational psychologist posts have been lost since 2010.

As well as the disparity between experiences of attending accident and emergency, there is a disparity between adults and children when it comes to health-based places of safety under the Mental Health Act. While I am sure that everybody would welcome the move to end the practice of detaining children and young people in police cells, Right Here, Right Now says:

“The decrease in the use of police custody may not mean that people are more likely to be detained under section 136 in dedicated places of safety based in mental health services. It may be that a desire to avoid using police custody has moved the pressure to elsewhere in the local system”.

It also says:

“We also had concerns about the provision of appropriate places of safety for children and younger people. We found that too many providers had policies that excluded young people from all their places of safety … These restrictions created untenable situations where people under 18 were one and a half times more likely to end up in police custody. However, there has been a major drive to reduce the number of children and young people in police custody”,

which we welcome. It goes on to say:

“Between 2012/13 and 2013/14, the percentage of under 18s detained in police custody fell from approximately 45% to around 31% ... This is a positive achievement, but it still means that nearly one in three people under 18 ended up in police custody rather than somewhere they could receive appropriate treatment”.

I have some questions for the Minister. Future in Mind, the report of the Children and Young People’s Mental Health and Wellbeing Taskforce, states:

“If you have a crisis, you should get extra help straightaway, whatever time of day or night it is. You should be in a safe place where a team will work with you to figure out what needs to happen next to help you in the best possible way”.

For many children and young people, as the CQC report makes clear, this is simply not the case. What steps is the Department of Health taking to implement Future in Mind? Indeed, what are the Government doing to ensure that early intervention actually happens? How will they persuade the CCGs to give this the priority that it needs, as this is the obvious and oft repeated answer to how to mitigate these crises? Given the paucity of child-appropriate health-based places of safety, as the CQC highlights, does the Minister share the CQC’s concern that the banning of police cells, while most welcome, will create pressure in other parts of the system? Does the department have any solutions?

In Stamp Out Stigma, the Time to Change campaign seeks to tackle the stigma surrounding mental health and to break the taboo that is often associated with mental health problems. I was recently surprised to read the comments made by a Member of this House about mental health, which illustrates why we need to be on our guard not to perpetuate, even by accident, the stigma that goes with mental health issues. In a discussion about lowering the voting age, a noble Lord said:

“My Lords, does the Minister agree that an important part of due diligence in the policy of lowering the voting age would be to consult child development experts? Is she interested to learn that the view of a child development expert who has treated 16 and 17 year-olds for depression, eating disorders and other health issues over many years is that while quite a few 16 and 17 year-olds would be old enough to make a good decision in this area, many would not?”.—[Official Report, 1/6/15; col. 157.]

Several arguments can be made about not lowering the voting age. The issue of mental health is not one of them. In fact, it is probably a rather dangerous road down which to tread.

I have a final question for the Minister. Labour committed to enshrining in the constitution a right to mental health therapies. Just before the election, the Conservatives announced that they would do the same. The Government have launched a consultation, which has subsequently concluded. When can we see a response to that, and what action might be taken?

Right Here, Right Now highlights yet again that mental health services are failing and that this is a very unsatisfactory situation that creates terrible distress, stress and heart break, and sometimes even worse, for people with mental health problems and their families.